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106 Cards in this Set
- Front
- Back
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Lateral Hand in Flexion
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- relax digits to keep them superimposed
- thumb = parallel to IR - CR perpendicular to 2nd MCP joint |
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What does a lateral hand in flexion image show?
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Anterior or posterior displacement caused by fractures of metacarpals
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Norgaard Method - AP Oblique Hands
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- semi-supinated position
- put each hand on a 45 degree sponge (include both hands in image) - CR perpendicular @ MCP joint level |
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Why is the Norgaard method performed?
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- rheumatoid arthritis
- fracture of base of 2nd metacarpal |
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Norgaard Method Modified
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- "ball catcher's" position
- instead of extending fingers, fingers are cupped as if catching a ball |
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AP Wrist
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- arm & hand supinated
- patient should lean slightly lateral - CR to carpals - provide support for fingers |
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What is seen better on an AP wrist rather than a PA wrist?
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Carpal Interspaces
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AP Oblique Wrist - Medial Rotation
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- rotate wrist medially (internally) to reach 45 degrees
- CR perpendicular @ midcarpals - separates the pisiform from adjacent carpals |
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PA Wrist - Ulnar Deviation
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- Hold wrist joint in place and move elbow away from patient's body, turn hand outward until it's in extreme ulnar deviation
- CR perpendicular to scaphoid - Shows: scaphoid, navicular, & joint spaces adjacent to it |
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PA Wrist Radial Deviation
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- Hold wrist joint in place, move elbow towards body, turn hand medially
- Show: interspaces between carpals on medial side of wrist |
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PA Axial Wrist - Stecher Method
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- arm & axilla should be in contact w/ table
- IR placed on 20 degree sponge, place wrist so that fingers are elevated (can also angle tube 20 degrees towards elbow) - CR perpendicular to scaphoid - Shows: Scaphoid w/o superimposition |
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Alternative Stecher Method - Bridgman Method
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- position as if for Stecher, place wrist in ulnar deviation
- Shows: more open joint spaces adjacent to Scaphoid |
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Gaynor-Hart Method - Tangential Carpal Canal
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- Hand hyperflexed
- CR to palm 1" distal to 3rd metacarpal base - Tube angled 25-30 degrees toward palm - Shows: fractures of carpal bones |
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AP Medial Oblique Elbow
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- arm extended & in contact w/ table
- pronate hand & adjust anterior surface of elbow to 45 degrees - CR perpendicular to elbow joint - coronoid process of ulna in profile |
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Acute Flexion - Distal Humerus
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- elbow fractures are sometimes treated w/ elbow in acute flexion (Jones technique)
- patient seated w/ elbow fully flexed - CR perpendicular to humerus 2" superior to olecranon process, |
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Radial Head 4 Position Series - Position 1
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- lateral elbow position w/ hand supinated (elbow flexed)
- entire arm in contact w/ table - CR perpendicular to joint |
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Radial Head 4 Position Series - Position 2
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- lateral elbow position w/ lateral "karate chop" hand
- radial head well seen even though it's partially superimposed by coronoid process |
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Radial Head 4 Position Series - Position 3
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- lateral elbow position w/ hand pronated (palm as flat as possible)
- radial tuberosity facing posterior |
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Radial Head 4 Position Series - Position 4
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- lateral elbow position w/ hand internally rotated (same position for thumb as an AP thumb)
- radial tuberosity facing posterior |
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Coyle Method - Axiolateral Radial Head & Coronoid Process
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- patient seated w/ humerus, elbow & wrist in same plane
- hand palm down - CR 45 degrees towards elbow - Shows: Radial head & capitulum |
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How can the Coyle Method show the coronoid process?
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- angle of elbow only 80 degrees
- CR angled away from should 45 degrees toward elbow joint (beam goes over your shoulder somewhat) |
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Holly Method - Tangential Sesamoid
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- supine, heel in contact w/ IR, pull toes back so ball of foot is perpendicular to IR
- CR perpendicular to head of metatarsals - risk of magnification (large OID) |
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Lewis Method - Tangential Sesamoid
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- prone, great toe in contact w/ IR, ball of foot perpendicular to IR
- CR to 2nd metatarsal |
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AP Axial Projection - Weight Bearing Method
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- IR on floor if possible w/ patient upright, weight distributed evenly between feet
- CR angled 10 degrees towards heel - CR to space in between feet @ level of 3rd metatarsal |
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Lateral Foot - Weight-Bearing Method
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- Performed safest using a slotted low riser step build for this purpose; put IR in between feet (some should be below the foot)
- Shows: longitudinal arch of foot |
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Coalition Method - Axial Calcaneus Weight Bearing
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- Patient upright w/ affected foot on IR
- CR angled 45 degrees anteriorly through the posterior surface of flexed ankle to a point on the plantar surface @ level of 5th metatarsal base - Shows: calcaneotalar joint |
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AP Axial Projection - Weight Bearing Composite
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- (1)patient upright w/ IR under foot; place opposite foot 1 step back; CR 15 degrees posterior (toward heel) @ base of 3rd metatarsal; patient should not move foot after exposure
- (2) Tube behind patient, patient places opposite foot in front w/o moving foot on IR; CR angled 25 degrees anterior (towards toes) exiting @ level of lateral malleolus |
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Axial Heel Dorsoplantar Position
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- prone w/ elevated ankle w/ IR against entire plantar surface
- CR angled 40 degrees toward bottom of foot |
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Lateral Foot/Ankle - Lateromedial Position
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- supine w/ leg extended, turn away from affected side until foot is lateral
- CR perpendicular to ankle joint |
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Settegast Method - Patella/Patellofemoral Joint Tangential Projection
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- prone, flex knee slowly until patella is perpendicular to IR (or as much as patient can flex)
- CR tangential to patella This can also be done sitting up w/ IR above patella on thigh or lateral w/ IR next to patella |
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Merchant Method - Patella/Patellofemoral Joint Tangential Projection
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- 72" SID
- need to use a film/cassette holder - patient is seated w/ knees flexed 40 degrees off table - IR perpendicular to CR - CR angled 30 degrees towards femur |
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Hughston Method - Patella/Patellofemoral Joint Tangential Projection
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- prone, flex knee so tib/fib makes a 50=60 degree angle to table
- CR angled 45 degrees through patellofemoral joint |
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Mesocephalic Skull
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- petrous ridges form 47 degree angle to median plane
- "normal" skull |
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Brachycephalic Skull
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- petrous ridges form 54 degree angle to median plane
- internal structures are higher w/ reference to IOML - "short & fat" skull |
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Dolichocephalic Skull
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- petrous ridges form 40 degree angle to median plane
- internal structures lower w/ reference to IOML - "long & skinny" skull |
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What does the nasion intersect?
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Mid-Sagittal Plane & Interpupillary Line
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Which line is parallel to the midcoronal plane?
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Glabelloalveolar Line
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Which line is the radiographic base line?
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OML (Orbitolmeatal Line)
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Which line is used for lateral projections of the head?
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IOML (Infraorbitolmeatal Line)
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Which line is used for AP/PA projections of the head?
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OML
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What does AML stand for?
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Acanthiomeatal Line
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What does MML stand for?
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Mentomeatal Line
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Which bones make up the calvaria?
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Frontal, Occipital, Right & Left Parietal
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Which bones make up the floor of the skull?
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Ethmoid, sphenoid, right & left temporal
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Frontal Bone Components
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- contains supraorbital groove (right above eyebrows), glabella (between eyebrows), frontal sinus, & supercillary arches (ridge of bone above eyebrow)
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Parietal Bone Components
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- sides of cranium & cranial vault
- articulates w/ other parietal, frontal bone, occipital, temporals, & sphenoid |
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Occipital Bone Components
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- makes up most of the cranial floor & the posterior cranial vault
- contains foramen magnum (where SC enters cranial cavity), occipital condyles (form occipitoatlantal joints w/ C1), & external occipital protuberance (projection superior to foramen magnum) |
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Temporal Bone Components
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- makes up the inferior part of the sides of the cranium & part of cranial floor
- zygomatic process articulates w/ zygomatic bone - contains petrous portion & ridge (contains middle & inner ear), mastoid process (contains all mastoid air cells), EAM, carotid foramen, jugular foramen & styloid process |
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What 2 bones make up the TMJ?
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Mandibular fossa & mandibular condyle
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Sphenoid Bone
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- anterior to temporal bones on cranial floor & posterior to frontal bone
- ONLY BONE THAT ARTICULATES W/ ALL OTHER CRANIAL BONES - greater wings make posterior wall of orbit; pterygoid processes form lateral wall of nasal cavity |
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Sella Turcica
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- saddle shaped
- HOUSES PITUITARY GLAND |
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Ethmoid Bone
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- makes up anterior cranial floor, medial orbital walls, superior portion of nasal septum, & lateral walls of nasal cavity
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Cribiform (Horizontal) Plate
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Forms roof of nasal cavity; olfactory nerves pass through
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Superior & Middle Nasal Conchae
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- extend medially from ethmoid
- aid in cleansing & warming inhaled air |
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What are the sutures of the skull?
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Saggital, Coronal, Lambdoid, & Squamous
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To get the OML perpendicular to IR in an AP position for a hypersthenic patient, you would...
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Place support under their head
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To get the OML perpendicular to IR in an PA position for a hypersthenic patient, you would...
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Put support under forehead
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To get the OML perpendicular to IR in an PA position for a hyposthenic patient, you would...
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Put support under their chest
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To get the mid-sagittal plane parallel to IR in a lateral position for asthenic or hyposthenic people, you would...
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Place support under chest
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To get the mid-sagittal plane parallel to IR in a lateral position for hypersthenic people, you would...
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Place support under head
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AP Axial Skull
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- CR perpendicular to nasion OR 15 degrees cephalic to nasion
- MSP & OML perpendicular to IR |
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PA Axial Caldwell Method
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- prone or seated upright
- OML perpendicular to IR - CR angled 15 degrees caudal exiting nasion |
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What image are orbital bones best seen on?
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PA Axial Caldwell Skull
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Lateral Skull
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- patient standing, sitting, or semi-prone
- MSP & IOML parallel to IR - Interpupillary line is perpendicular to IR |
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A cross table (dorsal decubitus) lateral skull is done for...
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- trauma
- air fluid levels - patient condition |
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AP Axial Towne Method
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- MSP perpendicular & centered to IR; OML perpendicular
- upper margin of IR @ level of highest point of cranial vertex - CR angled 30 degrees caudal if OML is perpendicular (37 degrees of IOML is perpendicular); 2.5" above glabella |
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To demonstrate the entire foramen magnum in a trauma case, the tube angle should be increased to....
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40-60 degrees caudal
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Submentovetical Projection
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- IOML as parallel w/ IR as possible (head tilted way back); IOML perpendicular to CR
- CR between gonion at a point 1/4" anterior to EAM |
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What are the 4 pairs of sinuses?
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Frontal, ethmoid, sphenoid, & maxillary
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Why must sinus images always be done with the patient upright?
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To check air-fluid levels
Radiographic density is very critical & can be misleading if improper |
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Overpenetration of the sinuses causes...
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No pathology to be seem sometimes
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Underpenetration of the sinuses causes...
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Pathologic conditions that aren't actually there
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What kind of focal spot should be used when imaging sinuses?
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Small focal spot
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Lateral Sinuses
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- MSP & IOML parallel to IR
- interpupillary line perpendicular to IR - CR 1" posterior outer canthus - suspend respiration |
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Which sinuses are most important in the lateral view?
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Sphenoid
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PA Axial Sinuses Caldwell Method - Frontal Sinuses
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- IR tilted 15 degrees, CR horizontal
- OML perpendicular to IR, rest patient's head & nose on IR - CR exits nasion - Method is preferred = smaller OID |
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Alternative Caldwell Method (No IR Tilt)
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- extend patient's neck, rest tip of nose on IR & center to nasion
- OML forms 15 degree angle w/ CR - suspend respiration |
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PA Sinuses - Ethmoidal Sinuses
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- MSP & nasion centered to IR
- forehead & nose rest on IR - OML perpendicular to IR - suspend respiration |
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PA Sinuses - Sphenoidal Sinuses
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- glabella centered to IR
- MSP & OML should be perpendicular to IR - CR 10 degrees cephalic exiting glabella OR tilt IR 10 degrees downward - suspend respiration |
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PA Sinuses - Maxillary Sinuses
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- center IR midway between the infraorbital margins & the acanthion, center CR to IR
- patient's forehead & nose rest on IR, MSP perpendicular w/ IR |
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SMV Sinuses
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- IOML parallel to IR, CR perpendicular to IOML (head tilted way backwards, hurts a lot)
- mouth should be closed - CR to 3/4" anterior to EAM along MSP - suspend respiration |
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What happens if a patient cannot fully tilt their head back for an SMV image?
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Can tilt the bucky so that the IOML is parallel to it, with the CR directed perpendicular to IOML
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Which sinuses does the SMV image show?
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Sphenoid & Ethmoid
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Waters Position - Sinuses
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- MML perpendicular to IR, OML creates a 37 degree angle w/ IR
- rest patient's chin on IR - CR perpendicular, exiting the acanthion |
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What does the waters view for sinuses show?
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Place petrous ridges below maxillary sinuses
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Waters Open Mouth Position - Sinuses
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- positioned as for a normal Waters, then ask patient to drop their jaw w/o moving anything else
- CR same as for Waters - suspend respiration - can be used instead of an SMV if patient cannot tilt head backwards |
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What does the waters open mouth position show?
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Sphenoid sinuses
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How many facial bones are there?
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14
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What is the only facial bone the maxillae doesn't articulate with?
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Mandible
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The angle of the mandible is also known as the...
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Gonion
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How many bones make up the orbit?
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7 - frontal, sphenoid, zygomatic, maxillae, lacrimal, ethmoid, & palatine
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Lateral Facial Bones
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- same position as lateral skull
- CR enters the zygomatic bone in between the EAM & outer canthus - IOML parallel to IR |
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Lateral Nasal Bones
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- same position as lateral facial bones
- need to image both sides - CR enters perpendicular to nasion - technique reduced to show soft tissue & nasal bones |
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Waters Method (Parietoacanthial Projection) - Facial Bones
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- MSP centered to midline of IR
- same position as Waters for sinuses - CR perpendicular exiting the acanthion |
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What does the waters for facial bones show?
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Orbits, maxillae, & zygomatic arches
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Reverse Waters - Facial Bones
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- done if patient cannot be prone or upright
- causes magnification of facial bones - MML needs to be perpendicular w/ IR, parallel w/ CR - if unable to extend neck (trauma), angle tube 30 degrees cephalic entering the acanthion |
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Caldwell Method - Facial Bones
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- prone or upright; MSP centered to midline of IR w/ forehead resting on bucky
- OML perpendicular to IR - CR angled 15 degrees caudal exiting the nasion |
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How is a Caldwell for facial bones performed for a hypersthenic patient?
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Place sponge directly in front of forehead
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Which view does a Panorex of the Mandible qualify for?
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Lateral view (AP/PA must also be done)
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PA Mandibular Rami
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- prone or upright, OML & MSP perpendicular to IR
- CR perpendicular exiting the acanthion - for an axial view, angle CR 20-25 degrees cephalic still exiting the acanthion |
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What's the rotation on the patient's head if the symphysis of the mandible is ordered?
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Rotate head 45 degrees towards IR
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Towne/Grashey Method - AP Axial Mandible
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- OML & MSP perpendicular
- CR angled 35 degrees caudal entering glabella - Shows: condyloid processes & mandibular rami |
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SMV of Mandible
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- upright or supine; MSP centered to IR
- CR perpendicular to IOML midway between angles of mandible (in between chin & Adam's apple) |
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Rhese Method - Parietoorbital Oblique Projection
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- prone, rest cheek (zygoma) / nose / chin on IR (3 point landing)
- arms in comfortable position & shoulders in same plane - MSP at a 53 degree angle to IR |
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SMV of Zygomatic Arch
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- MSP centered to midline of IR; IOML perpendicular to IR if possible
- CR enters MSP 1" posterior to outer canthus |
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TMJ Image
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- open & closed mouth AP axial & axiolateral projections (weird looking dude on the 3rd to last slide w/ his mouth open)
- AP: CR angled 35 degrees caudal entering 3" above nasion at MSP |
